Procedures for the Granting and Calculation of the Insurance Compensation of the Compulsory Social Insurance in Respect of Accidents at Work and Occupational Diseases

Issued pursuant to
Section 8 and Section 12, Paragraph two
of the law On Compulsory Social Insurance
in Respect of Accidents at Work and Occupational Diseases

I. General Provision

1. This Regulation prescribes the procedures for the granting and calculation of the insurance compensation of the compulsory social insurance in respect of accidents at work and occupational diseases (hereinafter - the insurance in respect of accidents at work), and also the procedures for the calculation of the average wage subject to insurance contributions in order to determine the amount of insurance compensation.

II. Granting Insurance Compensation

2. A division of the State Social Insurance Agency (hereinafter - the Agency) shall examine the issue regarding granting an insurance compensation on the basis of:

2.1. a written request of the socially insured person (hereinafter - the insured person) or his or her successor in the right to compensation to grant the insurance compensation where the given name, surname, personal identity number, phone number or electronic mail address, account number in a credit institution or postal payment system and the type of the requested compensation are indicated;

2.2. the information provided electronically by the State Labour Inspectorate on the accident occurred at work or opinion regarding the occupational disease which is issued in conformity with the laws and regulations regarding the procedures for the investigation of occupational diseases and accounting thereof;

2.3. the documents referred to in Sub-paragraph 11.2, 14.2, 18.¹ 2, 18.¹ 3, 18.¹ 4, 18.² 2, 18.² 3, 18.² 4, 18.⁴ 2, 18.⁴ 3, 18.⁷ 2, 18.⁷ 3, 18.⁸ 2, 21.2, 21.3, 21.4, 21.5, 21.6 or 24.2 of this Regulation and information which confirms the right to the relevant type of insurance compensation.

[4 January 2005; 9 December 2008; 19 July 2011; 30 June 2015]

3. The Agency shall take a decision to grant an insurance compensation or to refuse to grant an insurance compensation and notify it to the insured person or successor in the right to compensation within the time period and in accordance with the procedures laid down in the Administrative Procedure Law.

[19 July 2011]

4. [9 December 2008]

5. [16 February 2010]

6. A division of the Agency is entitled to examine documents and information provided by employers, insured persons and successors in the right to compensation.

[4 January 2005]

7. If the insured person has the right to compensation for the loss of the capacity for work or the successor in the right - for the loss of a provider, but more time than is provided in Paragraph 3 of this Regulation is needed for determining the amount of insurance compensation, a division of the Agency is entitled to disburse the insurance compensation to the requester as advance payment the amount of which does not exceed the amount of the State social security benefit.

[4 January 2005]

8. If the person who receives compensation for the loss of the capacity for work or compensation for the loss of a provider departs for permanent residence in foreign states, the granted insurance compensation shall be disbursed in accordance with the procedures laid down in accordance with the law On State Pensions for persons who depart to foreign states.

[30 June 2015]

9. [30 June 2015]

10. If the request for the disbursement of an insurance compensation is not renewed or other documents requested by the Agency are not submitted, a division of the Agency shall discontinue the disbursement of the insurance compensation starting from 1 January of the next year.

[4 January 2005]

III. Sickness Benefit

11. A decision to grant the sickness benefit shall be taken on the basis of:

11.1. the documents referred to in Sub-paragraphs 2.1 and 2.2 of this Regulation;

11.2. a sick-leave certificate drawn up in the unified electronic information system of the health sector or a document confirming the incapacity for work issued in a foreign state and certified in accordance with the procedures laid down in the laws and regulations.

[30 June 2015]

12. The sickness benefit shall be granted for calendar days and the amount of the benefit shall be calculated by using the following formula:

Ps = Vd x Dn x 0.8, where

Ps - the amount of the sickness benefit;

Vd - the average wage subject to insurance contributions per calendar day;

Dn - the number of calendar days of the time period of the incapacity for work which is to be paid in accordance with the law On Compulsory Social Insurance in Respect of Accidents at Work and Occupational Diseases.

13. If the information on temporary incapacity for work is received in a division of the Agency, but the documents certifying the insurance event have not been received within ten days, the sickness benefit shall be calculated for and disbursed to the insured person in accordance with the law On Maternity and Sickness Insurance. After receipt of all documents certifying the insurance event, the sickness benefit shall be recalculated for the insured person in accordance with the law On Compulsory Social Insurance in Respect of Accidents at Work and Occupational Diseases.

[4 January 2005; 30 June 2015]

IV. Compensation for the Loss of the Capacity for Work

14. A decision to grant the compensation for the loss of the capacity for work shall be taken on the basis of:

14.1. the documents referred to in Sub-paragraphs 2.1 and 2.2 of this Regulation;

14.2. the information provided electronically by the State Medical Commission for the Assessment of Health Condition and Working Ability (hereinafter - the Commission) on the loss of the capacity for work and disability of the person. If the information cannot be submitted electronically, the extract from the statement of the Commission on the loss of the capacity for work (in per cent) and a copy of the disability statement shall be submitted to the Agency in printed form.

[16 February 2010]

15. A compensation for the loss of the capacity for work shall be calculated by using the following formula:

A - compensation for the loss of the capacity for work;

Vm - the monthly average wage subject to insurance contributions of the insured person;

Iz - the compensation for the loss of the capacity for work (in per cent).

16. A compensation for the loss of the capacity for work shall be determined by taking into account the loss of the capacity for work (in per cent) and the relevant compensation for the loss of the capacity for work (in per cent) in accordance with the Table:

[16 February 2010]

17. Compensation for the loss of the capacity for work shall be disbursed to the insured person for the current month on the day specified by a division of the Agency.

[4 January 2005]

17.¹ If the loss of the capacity for work is determined repeatedly and the interruption when the loss of the capacity for work for the insured person (assessment in per cent) giving the right to the compensation has not been longer than five years, the disbursement of the compensation for the loss of the capacity for work shall be renewed. When renewing the disbursement of the compensation, it shall be reviewed by taking into account all indexes which have been applied to it before the renewal thereof. If more than five years have passed, the compensation for the loss of the capacity for work shall be granted anew.

[30 June 2015]

18. Compensation for the loss of the capacity for work shall be recalculated from the day when the circumstances which are the basis for the recalculation of the compensation have set in if:

18.1. in accordance with the decision of the Commission the assessment of the loss of the capacity for work (in per cent) changes. In such case the compensation shall be recalculated by taking into account all consumption price indexes which have been applied to the compensation before the recalculation thereof, however without any changes in the average wage subject to insurance contributions applied for the granting of the compensation;

18.2. the insured person has been granted the old-age or service pension;

18.3. imprecisions have been detected in the submitted documents and the amount of the compensation for the loss of the capacity for work changes by rectifying them;

18.4. there is a court ruling due to the execution of which the amount of the compensation for the loss of the capacity for work changes;

18.5. the Commission has determined the need for a special care for the insured person in relation to functional disorders;

18.6. [30 June 2015]

[16 February 2010; 19 July 2011; 22 July 2014; 30 June 2015]

IV¹. Compensation of Additional Expenses

[19 July 2011]

18.¹ Expenses for the health care services (including medical treatment in a medical rehabilitation institution), unless the State guaranteed medical rehabilitation of the second stage is applied, and for medicinal products, and also patient's fee, if the State guaranteed medical rehabilitation of the second stage is received, shall be compensated on the basis of:

18.¹ 1. the documents referred to in Sub-paragraphs 2.1 and 2.2 of this Regulation;

18.¹ 2. the form of medical documentation "Extract from the inpatient/outpatient medical treatment card", where the health care services provided to a person and necessity thereof are indicated;

18.¹ 3. the payment documents certifying the relevant expenses;

18.¹ 4. the referral of the attending physician for the receipt of the medical rehabilitation service.

18.² Expenses for the professional rehabilitation services shall be compensated to the person on the basis of:

18.² 1. the documents referred to in Sub-paragraphs 2.1 and 2.2 of this Regulation;

18.² 2. the information provided electronically by the Commission on the necessity for re-qualification appropriate for the health condition of the insured person or the acquisition of another profession. If it is not possible to obtain the abovementioned information electronically, the Commission shall submit it to the Agency in printed form;

18.² 3. the education documents certifying the receipt of professional rehabilitation services;

18.² 4. payment documents certifying the relevant expenses.

18.³ The Agency shall compensate to the insured person transport expenses related to a visit of the medical treatment institution in accordance with the following procedures:

18.³ 1. expenses for using a public transport (except for a taxi) - in conformity with the rate for transportation in the relevant vehicle;

18.³ 2. if it is not possible to visit a medical treatment institution due to the lack of public transport or health condition of the insured person, the expenses for the use of a private vehicle - in conformity with a travel route, mileage and fuel consumption of the relevant vehicle.

18.⁴ Transport expenses shall be compensated on the basis of:

18.⁴ 1. the documents referred to in Sub-paragraphs 2.1 and 2.2 of this Regulation;

18.⁴ 2. the form of medical documentation "Extract from the inpatient/outpatient medical treatment card", where the dates of visits to a medical treatment institution and health care services provided are indicated;

18.⁴ 3. source documents confirming the actual transport expenses (public transport tickets, cashier receipts of a fuel station or receipts).

18.⁵ The Agency shall, on the basis of the form of medical documentation "Extract from the inpatient/outpatient medical treatment card" where there is the indication of the attending doctor regarding the necessity of an assistant, compensate transport expenses for the insured person incurred while accompanying the person from his or her place of residence to the medical treatment institution and back again. The abovementioned expenses shall be compensated in the same amount in which the transport expenses are compensated for the person if he or she uses public transport to get to the medical treatment institution.

18.⁶ The insurance compensation for covering expenses for the purchase of technical aids shall be granted unless the relevant technical aids are purchased from the State budget resources.

18.⁷ Expenses for the purchase and repair of technical aids shall be compensated on the basis of:

18.⁷ 1. the documents referred to in Sub-paragraphs 2.1 and 2.2 of this Regulation;

18.⁷ 2. the information provided electronically by the Commission on the disability or loss of the capacity for work of the person;

18.⁷ 3. the opinion of the attending physician or ergo-therapist regarding the necessity of the relevant technical aid.

18.⁸ The insurance compensation shall be granted in increased amount for ensuring permanent care on the basis of:

18.⁸ 1. the documents referred to in Sub-paragraphs 2.1 and 2.2 of this Regulation;

18.⁸ 2. the information provided electronically by the Commission on the disability of the persons, loss of the capacity for work and end of the time period of necessity of special care.

18.⁹ The insurance compensation shall be disbursed in increased amount until the end of the time period of disability, loss of the capacity for work and necessity of special care laid down by the Commission. If after the end of the time period of loss of the capacity for work laid down by the Commission the permanent care is no longer necessary for the person, the Agency shall recalculate the amount of the compensation for the loss of the capacity for work in conformity with the general conditions.

V. Lump Sum Benefit

[16 February 2010]

VI. Compensation for the Loss of a Provider

21. A decision to grant the compensation for the loss of a provider shall be taken on the basis of:

21.1. the documents referred to in Sub-paragraphs 2.1 and 2.2 of this Regulation;

21.2. the statement from the medical treatment institution regarding relation of the cause of death of the insured person with the accident or occupational disease;

21.3. information on the registration of the fact of death;

21.4. the documents which certify the kinship or marriage of the successor in the right to compensation with the insured person - the certificate of birth and/or certificate of marriage (shall be presented);

21.5. the information of the Commission on the disability of the person if the disability has been determined for the successor in the right to compensation;

21.6. the court judgment on the fact of provision of maintenance if on the basis of the documents referred to in Sub-paragraphs 21.4 and 21.5 of this Regulation it is not possible to establish the fact of full or partial provision of maintenance.

[1 January 2005; 16 February 2010; 19 July 2011]

22. If the total amount of the compensation for the loss of a provider which is calculated for the persons under maintenance exceeds 80 % of the average monthly wage subject to insurance contributions of the insured person, the amount of the compensation for the loss of a provider shall be reduced for each person accordingly (by retaining the proportion which is established between the amounts of the compensation for the loss of a provider in the beginning of the calculation) in order not to exceed the limitation laid down in the law On Mandatory Social Insurance against Accidents at Work or Occupational Disease in respect of the total calculated amount.

22.¹ Upon change of the number of dependants, the compensation for the loss of a provider shall be recalculated by taking into account all consumption price indexes which have been applied to the compensation before the recalculation thereof, however not changing the average wage subject to insurance contributions applied for granting the compensation.

[22 July 2014]

23. Compensation for the loss of a provider shall be disbursed to the insured person for the current month on the day determined by a division of the Agency.

[4 January 2005]

VII. Funeral Benefit

24. A decision to grant the funeral benefit shall be taken on the basis of:

24.1. the documents referred to in Sub-paragraphs 2.1 and 2.2 of this Regulation;

24.2. the information on the registration of the fact of death.

[9 December 2008; 19 July 2011]

25. [9 December 2008]

26. The amount of the funeral benefit shall be calculated by using the following formula:

Pa = Vd x 2 x Dv, where

Pa - the amount of the funeral benefit;

Vd - the average wage subject to insurance contributions per calendar day of the deceased socially insured person;

Dv - average number of the days in the time period laid down in Paragraph 27 of this Regulation.

26.¹ If a person who has received the compensation for the loss of the capacity for work is dead, the amount of the funeral benefit shall be calculated by using the following formula:

Pa = A x 2, where

Pa - the funeral benefit;

A - compensation for the loss of the capacity for work.

[4 January 2005]

VIII. Calculation of the Average Wage Subject to Insurance Contributions

27. The average wage subject to insurance contributions shall be calculated for the insured person from the wage subject to insurance contributions for the time period which is laid down in Section 12, Paragraph one or four of the law On Compulsory Social Insurance in Respect of Accidents at Work and Occupational Diseases.

[4 January 2005]

28. If the insured person has had a temporary incapacity to work before the day of detection of the occupational disease, the average wage subject to insurance contributions of the person shall be determined from the wage subject to insurance contributions for the time period of 12 calendar months before the day of setting in of the temporary incapacity to work during the time period which ends at least two calendar months before the month in which the insurance event has occurred.

[4 January 2005; 16 February 2010]

29. The entire wage subject to insurance contributions which the insured person has earned as an employee during the time period laid down in Paragraph 27 or 28 of this Regulation shall be included in the wage subject to insurance contributions if during this time period the employer has made or he or she had to make social insurance contributions for insurance against accidents at work, except supplements, bonuses, benefits and remuneration of other type which the employer in accordance with a collective agreement or that laid down in the employment agreement has disbursed to the person during a temporary incapacity to work or during the time period when the person was on prenatal and postnatal maternity leave, childcare leave or leave without maintaining the remuneration for work which has been granted in relation to the necessity to take care for a child.

[30 June 2015 / Amendment to Paragraph shall come into force on 1 January 2016 / See Paragraph 3 of the Amendments]

30. In order to determine the amount of the compensation for the loss of the capacity for work and the compensation for the loss of a provider, the average wage subject to insurance contributions shall be calculated by using the following formula:

Vm = (A1+ A2 + .. + A12) : B, where

Vm - average monthly insurance contribution wage;

A1, A2... - the amount of the wage subject to insurance contributions which is earned in the relevant calendar month of the time period laid down in Paragraph 27 or 28 of this Regulation and from which the employer has made or she or he had to make the social insurance contributions for insurance against accidents at work;

B - the number of months for which the social insurance contributions for insurance against accidents at work have been made or had to be made during the time period laid down in Paragraph 27 or 28 of this Regulation.

[16 February 2010]

31. In order to determine the amount of the sickness benefit and funeral benefit, the average wage subject to insurance contributions shall be calculated by using the following formula:

Vd = (A1 + A2 + .. +A12) : D, where

Vd - the average wage subject to insurance contributions per calendar day;

A1, A2 ... - the amount of the wage subject to insurance contributions which is earned in the relevant calendar months of the time period laid down in Paragraph 27 of this Regulations and from which the employer has made or he or she had to make social insurance contributions for insurance against accidents at work;

D - the number of days for which the social insurance contributions for insurance against accidents at work have been made or had to be made during the time period laid down in Paragraph 27 of this Regulation.

[16 February 2010]

32. If the insured person has not had a wage subject to insurance contributions in the time period laid down in Paragraph 27 or 28 of this Regulation then:

32.1. in order to determine the amount of the compensation for the loss of the capacity for work and the compensation for the loss of a provider, it shall be assumed that the average monthly wage subject to insurance contributions is the amount of 40 per cent of the average wage subject to insurance contributions determined in the Sate (in the calendar year which ends in the year before the year in which the insurance event has occurred);

32.2. in order to determine the amount of the sickness benefit and funeral benefit, the average wage subject to insurance contributions of the calendar day shall be calculated by using the following formula:

Vd = Vvid x 0,4 x 12 : Dk, where

Vd - the average wage subject to insurance contributions per calendar day;

Vvid - the average wage subject to insurance contributions laid down in the State (in the calendar year which ends in the year before the year in which the insurance event has occurred);

Dk - the number of calendar days of the time period laid down in Paragraph 27 of this Regulation.

[3 April 2001; 4 January 2005; 16 February 2010]

33. [30 June 2015]

34. [9 December 2008]

IX. Closing Provisions

34.¹ [4 January 2005]

35. Cabinet Regulation No. 150 of 22 April 1997, Procedures for Creating the Means for Compulsory Social Insurance in Respect of Accidents at Work and Occupational Diseases and Use Thereof (Latvijas Vēstnesis, 1997, No. 104/105; 1998 No. 235/236), is repealed.

36. The insured person for whom an insurance event has occurred until 31 December 2009, the average wage subject to insurance contributions for the determination of the amount of insurance compensation shall be calculated from the wage subject to insurance contributions for a period of six calendar months ending this period two calendar months before the month in which the insurance event has occurred.

[16 February 2010]

37. If the sick-leave certificate B is not drawn up electronically but in paper form in accordance with the procedures laid down in the laws and regulations by using a form of the sick-leave certificate, the person shall submit it together with a submission for granting a sickness benefit to any department of the State Social Insurance Agency.

[30 June 2015]

Prime Minister V. Krištopans

Minister for Welfare V. Makarovs

Translation © 2017 Valsts valodas centrs (State Language Centre)